Sciatica is a clinical syndrome characterized by pain radiating along the distribution of the sciatic nerve, typically extending from the lower back through the buttock and down the posterior or lateral aspect of the leg. It results from irritation, inflammation, or compression of one or more lumbosacral nerve roots and represents a symptom complex rather than a standalone diagnosis. Sciatica is a common reason for orthopaedic consultation due to its impact on mobility, function, and quality of life.

The most frequent causes of sciatica include lumbar disc herniation, spinal stenosis, degenerative disc disease, spondylolisthesis, and foraminal narrowing. Less common causes include tumors, infections, or inflammatory conditions. The nature and severity of symptoms depend on the degree of nerve root involvement and underlying pathology.

Patients typically present with sharp, burning, or electric shock–like pain radiating from the lower back into the leg, often following a dermatomal pattern. Pain may be accompanied by numbness, tingling, or weakness in the affected limb. Symptoms are commonly exacerbated by sitting, bending, coughing, or prolonged standing. In severe cases, functional impairment may significantly limit walking and daily activities.

Orthopaedic evaluation focuses on correlating clinical symptoms with neurological findings. Examination includes assessment of posture, spinal mobility, straight-leg raise testing, motor strength, sensory deficits, and reflex changes. Identifying red-flag symptoms such as progressive weakness or bowel and bladder dysfunction is critical, as these may indicate urgent pathology.

Imaging is guided by clinical presentation. MRI of the lumbar spine is the preferred modality when symptoms persist or neurological deficits are present, as it provides detailed visualization of nerve root compression and disc pathology. Imaging findings must be interpreted in conjunction with clinical symptoms, as asymptomatic disc abnormalities are common.

Management of sciatica is initially conservative in most patients. Treatment includes activity modification, physiotherapy focusing on core stabilization, pain control, and gradual return to function. Patient education regarding posture and ergonomics plays a crucial role in symptom resolution. Many cases improve with structured non-operative care.

Surgical evaluation is indicated when conservative treatment fails, pain remains disabling, or neurological deficits progress. Surgical intervention aims to relieve nerve compression and restore function. Appropriate patient selection is essential to achieving favorable outcomes.

Sciatica requires a structured orthopaedic approach emphasizing accurate diagnosis, staged management, and timely surgical evaluation when indicated to prevent chronic disability.